Helping incarcerated women overcome addiction is one of the most challenging feats for addiction counselors and behavioral health professionals. Incarcerated women report a history of trauma and abuse at a much higher rate than the general population (O’Brien, 2002). As a result, increased numbers of female offenders in the criminal justice system suffer from addiction and have experienced trauma (Sydney, 2005). To assist incarcerated women who have experienced trauma, addiction counselors and behavioral health professionals employ a number of trauma-informed interventions and other techniques to ameliorate the problem.
Unfortunately, women prisoners experience trauma at the hands of domestic partners and sexual assault behind bars. Traumatic events experienced in and out of incarceration make women more susceptible to substance dependence, relapse, and other mental health issues (Nowotny, Belknap, Lynch, & DeHart, 2014). Although traditional therapeutic interventions are adequate, the need for gender-responsive interventions and flexible behavioral strategies is essential. Policymakers are rethinking how to address the growing population of incarcerated women, while researchers address the most effective interventions. Storytelling can be a manageable way to package information in a way that gives meaning to these women’s individual stories and provides easy retrieval from memory (Miller, 2015). Storytelling may be just as effective as traditional approaches to address trauma, substance abuse, and criminal behaviors in incarcerated women.
The role of storytelling, role play, and film as therapeutic interventions are prominently highlighted in narrative psychology, which focuses on the way people integrate and internalize specific details and events to make sense of the world (Leeder & Wimmer, 2007). Historically, addiction counselors have used storytelling to help incarcerated women connect with their peers in therapeutic groups, but most importantly it can be used as a vehicle to access buried emotions. Specifically, storytelling has been an integral part of the recovery journey in therapeutic communities (TC), residential facilities, and outpatient programs. Conversely, role play is often used as an adjunct to storytelling. Role play affords clients opportunities to process their stories in the safety of groups.
Formulating the Problem
Women represent the fastest growing segment of incarcerated individuals in the criminal justice system (Frost, Green, & Pranis, 2006). As a population, incarcerated women lack gender-responsive interventions and learning strategies to deal with substance abuse and criminal behaviors (Frost et al., 2006). Sydney (2005) highlighted a sharp increase of female offenders in the criminal justice system, positing that this segment of the prison population doubled from 1990 to 2003. The Bureau of Justice Statistics reported, “women make up 23 percent of persons on probation and 12 percent of those on parole” (van Wormer, 2010, p. 3). The increase of incarcerated women and limited learning strategies to support desired behaviors may pose a potential risk of recidivism among this segment of the population.
Using storytelling and film as a learning strategy in other contexts has been successful (Blasco, Moreto, Blasco, Levites, & Janaudis, 2015; Vázquez, 2014; Delamarter, 2015). This strategy could be considered to address substance abuse and criminal behavior in incarcerated women as a flexible alternative that engages the emotional and intellectual nature of women dealing with traumatic memories. How people construct and tell their stories reflects and shapes who they are (Miller, 2015). Storytelling, as a learning strategy, can be a powerful tool for self-assertion that allows storytellers to reframe responses to trauma such as survival, resilience, and coping through reflection (Miller, 2015). Findings from this study may be of interest to counselors, social workers, and corrections officers who work with incarcerated women to prepare them for transition into the community.
Purpose and Research Question
The purpose of the qualitative narrative inquiry was to provide counselors who work with incarcerated women the opportunity to share narrative insights as to how film, documentaries, or other avenues of storytelling provided therapeutic support for incarcerated women. Storytelling had been used previously for therapeutic purposes (Blasco et al., 2015; Miller, 2015), though less is known about using film with this population. The narrative analysis research design allowed researchers to gather firsthand accounts of the experiences of participants. Counselors who work with incarcerated women and have used film as a therapeutic approach were able to observe and assist their clients to reflect on themes presented in the film. Findings of the exploratory research addressed gaps in the literature and provided insights that could be used to support practice-based innovations and further research. In addition, the findings—while not generalizable—may be transferred to women who were on parole in community settings as a point of comparison or for further testing. The geographic location of the research study was southern California, and the research population for the study were counselors who worked with incarcerated women serving time in the southern California penal system. As researchers, we sought to explore the experiences and observations of drug and alcohol counselors and how storytelling, role play, and film were used as strategies to affect positive behavioral change in incarcerated women. The intent led us to the following research question: How do counselors who work with incarcerated women describe their experience using storytelling, role play, and film as a therapeutic strategy to drive behavioral change in this population?
Method and Design
Narrative analysis was used in the current qualitative study to accurately capture the storytelling of research participants. Narrative analysis provided researchers the ability to assemble, understand participants’ narratives, and construct meaning from the experiences within specific populations based on the environment in which those participants live, work, and interact (Clandinin & Connelly, 2004; Gudmundsdóttir, 2001). Freeman (1997) described the role of narrative analysis as a means to develop a deeper understanding of the value of people’s life experiences, which other qualitative methodologies are not able to construe. Thus, storytelling can be seen as a powerful means to convey the insights and experiences of participants’ thoughts, emotions, and interpretations of life events (Chase, 2005).
In the context of storytelling, the role of the narrative analyst is to observe “the telling or retelling of an experience [that] entails a complex combination of description, explanation, analysis, interpretation, and construal of one’s private reality as it is brought into the public sphere” (Johnson & Golombek, 2011, p. 490). Traditionally in storytelling, a series of occurrences as shared by participants scaffold as a sequence of events and experiences. The construct of the stories shared by participants in this study may not be described in the exact order in which the events occurred. Narrative analysis is a collaborative enterprise, over a period of time, in which researchers and participants fully develop experiences into profound and personal stories (Clandinin & Connelly, 2000). In qualitative research, researchers become instruments of the study that gather and interpret data (Glesne, 2011). Therefore, the role of researchers when employing narrative analysis is to give meaning and interpret the sequence of participants’ stories logically and succinctly. Using narrative analysis allows researchers to acquire and further illustrate the stories, as revealed by participants, to promote a deeper understanding of the role of counselors’ use of film during therapeutic support sessions when working with incarcerated women who are serving sentences in southern California state prisons.
The population selected for this study was comprised of counselors who worked with incarcerated women in southern California and who used film to support behavioral change. The sample was drawn from a professional site constituting counselors who worked for the state prison systems where storytelling, role play, and film had been used in a therapeutic context. Participants in the study were certified or registered drug and alcohol counselors who had worked with incarcerated women for a minimum of six months. Participants ranged in age from eighteen to sixty years old—generally, drug and alcohol counselors retire or leave the field by the age of sixty. Participants’ average number of years as counselors in the addiction field was ten years.
The population and sample were purposively selected following guidelines established by Twining (2009), where the goal was to draw data from individuals best positioned to observe and comment on the research phenomenon of interest. Accordingly, the sample of interest were counselors who had experience using film as a therapeutic support for behavioral change. Counselors self-selected as participants in the study by responding to various announcements posted electronically at the principal writer’s LinkedIn website. Interested individuals returned the signed consent form to the lead researcher. The next step involved confirming that each potential participant met the criteria for inclusion in the study. The intention was to interview between five to ten addiction counselors who worked with incarcerated women in the California penal system. Ultimately, ten addiction counselors were interviewed.
Telephone, face-to-face, and open-ended survey interviews were conducted with individuals who had self-selected by responding to a notice posted at a professional social media site, signed the informed consent, returned it electronically, and were confirmed as meeting the criteria to participate in the study. Following the confirmation, each participant was contacted to set up a telephone or face-to-face interview. Six participants completed extensive interviews either in person or by telephone.
Additionally, several participants provided data through an online survey that featured open-ended questions. Each of the researchers participated in the interview. Every participant was identified by alphanumeric code throughout the entire process. Transcripts and related notes were all labeled with the code.
Participants received an advance copy of the interview questions for the interview, which lasted about an hour. While all interviewers took notes, one researcher was the primary transcriber. Following the interview, the transcript was reviewed by all team members who checked against their notes for any omissions or details. The transcript was sent to the participants for member checks within two weeks of the interview date.
Analysis began once participants verified the accuracy of the transcript. The inductive analysis followed participant verification and each researcher read all narratives following validation of the transcripts by the participants. Each researcher wrote an abbreviated narrative that captured key points of the stories gathered from participants. Shared narratives were considered separately and collectively by all three researchers. The narratives were used as an introduction to the thematic analysis developed using the transcripts. Extensive memoing (i.e., notes on what researchers are learning) about the transcripts was shared among the researchers, who reached consensus on emerging themes. A summary of themes was presented at the end of the analysis.
Results of Analysis
Ten drug and alcohol counselors who worked in the California Department of Corrections and Rehabilitation (CDCR) participated in the study. Each participant reported a minimum of two years and a maximum of eighteen years of experience working with incarcerated women with a primary substance abuse or dependence diagnosis. Drug and alcohol counselors referred to incarcerated women who participated in their sessions as “clients.” This nomenclature was used in context to humanely address the women as members of a collective group who were seeking the skills and means of personal betterment and fulfillment. An additional term used during the study to identify the incarcerated women was “students,” and this nomenclature highlighted the women’s position as learners in the program. The narrative analysis began with a description of the use of storytelling, role play, and film as viable tools to encourage incarcerated women to discuss connections to self, others, and their crimes. Subsequently, the discussion centered on an overview of dominant themes and subthemes, which were key to understanding counselors’ experiences when working with their clients.
Using a narrative analysis to capture the lived experiences of counselors who worked in the CDCR aptly summarized participants’ understanding of the use of movies, role play, and storytelling as important strategies to affect behavioral change in incarcerated women. The use of film as a behavioral strategy in corrections is not readily embraced as a mainstream counseling intervention.
Although storytelling and role play have been efficaciously used in other contexts (Blasco et al., 2015; Vázquez, 2014; Delamarter, 2015), this study highlights drug and alcohol counselors’ positive views of these strategies as effective tools in changing behavior in incarcerated women who suffer from drug and alcohol abuse and/or dependence.
Building Bridges: Awareness, Connections, Relationships, and Empowerment
The overarching theme of the study was “Building Bridges: Looking Back, Looking Forward” which represented the participating counselors’ view that the use of storytelling, role play, and film afforded incarcerated women the opportunity to connect current behaviors to past trauma. This view was reiterated in each participant’s story through key themes such as awareness, connections, relationships, and empowerment. Each theme was supported by several situation-specific subthemes distributed unevenly across stories that highlighted empathy, compassion, and healthy relationships. Subthemes were embedded in counselors’ observations and supported the broader themes of awareness, connections, relationships, and empowerment. Each theme is discussed in further detail in the following sections. Pseudonyms were identified for each counselor—Amy, David, Joan, Sue, Walter, and Yannick—and will be used throughout this section.
The theme of awareness laid the foundation for progressive scaffolding of the concepts of connections, relationships, and empowerment. Each of the themes built upon one another to demonstrate a direct correlation of how the therapeutic strategies of storytelling, role play, and film were symbiotic in nurturing the behavioral changes evoked within the incarcerated women.
Participants were reflective and insightful, recalling specific instances in which one or more of the behavioral strategies employed resonated with their clients. Working with their clients caused participants to pause and examine the process and overall effect the use of storytelling, role play, and film had on instilling an immediacy in the development of awareness. Furthermore, participants became aware of the prominent role they played when working with clients. Counselors’ shared life experiences, which in many instances were similar to their clients, helped clients realize they were not alone. The power of sharing personal stories or “walking the walk” gained counselors the respect of their clients. This connection highlighted the similarities in experiences and lifestyles between participants and their clients; thus, it increased participants’ awareness of their clients’ struggles with addiction.
The theme of awareness emerged as a result of observing client behaviors, their personal growth, and counselor/client interactions. Furthermore, empathy, as a subtheme of awareness, became clearer as Joan’s clients became more cognizant of the similarities between themselves and other group members. Joan reported that her clients often walked around the room, after listening to music, to appreciate the similarities in expression among their peers. This became the clients’ first opportunity to observe others and learn to decipher facial and emotional differences and similarities in expression. Clients’ ability to detect similarities in emotional expression between themselves and others may elicit empathy and deepen interpersonal connections. The documentary Children of the Camps (Ina & Holsapple, 1999) enabled these connections and greater awareness.
According to Amy, the theme of awareness was salient in the movie Collateral Beauty (Dorros et al., 2016). Although the movie’s primary theme centered on relationships, clients were able to connect other themes in the movie to their own feelings of grief and loss; thus, making them more responsive to the film’s characters. Sensitivity to the storyline and the problems highlighted in the movie allowed clients to empathize with the characters. This was evident in their ability to identify with characters in the film.
The process of storytelling is significant because it helps clients gain personal awareness and empathy by listening to the stories of fellow inmates. Amy reported that a client’s disclosure of newly acquired insight caused a domino effect in the group. Clients garnered increased awareness of their environment and of each other, “connect more to their pain and personal story, and therefore demonstrate growth.” For example, one of Amy’s clients became notably softer, more polite, and more respectful after seeing those behaviors modeled in film. The client even renounced previous behaviors, stating that she dreamt of becoming a drug and alcohol counselor instead. Amy further noted the following: “Change happens, awareness happens, and empathy is cultivated naturally.” Her saying symbolizes the connections between change, awareness, and the ability to empathize with others.
Results from this study showed a natural flow from the theme of connections to that of awareness; which was further supported by the subtheme of compassion. Reflecting on the stories highlighted and the connections between themes, the counselors began their work with a fragile population by connecting their personal past experiences to similar stories. By employing this strategy, incarcerated women reexperienced their own stories in the safety of the group, knowing they were not alone on the journey to recovery. Openly communicating via storytelling, role play, and film facilitated discussion about clients’ trauma, which was shared in a safe environment with other group members. The connections formed extended from clients’ ability to show empathy to another’s plight.
Sue’s clients experienced change though what she referred to as “a light-bulb moment”; for example, clients realized that they were not alone on the journey (“Oh, I’m not the only one”). The use of storytelling, role play, and film can be seen as a bridge that connects clients to each other and the therapeutic process; this connection highlights what counselors refer to as “the theory of universality.” Sue believes there are different types of bridges just as there are different types of clients. A bridge can be used to go back to the past, through to reflection, or forward to forgiveness, so the bridge symbolizes connections to the past, present, and future.
Although Walter did not express a direct connection to his clients, mostly because of gender differences, he noted that he could relate to their experiences as addicts. He reflected on his work with incarcerated women, noting that “the connection between women is not necessarily present between incarcerated men.” Walter’s use of storytelling and role play focused on connecting with female clients from the standpoint of a safe role model. He described these strategies as a bridge that connected clients in a safe milieu.
Walter used role play as an effective therapeutic strategy; for example, his clients listened to the song Rolling in the Deep by Adele (Adkins & Epworth, 2010), as a way to connect to traumatic events that reminded them of being in deep dark waters. Walter and other counselors are cognizant that role play and similar strategies (e.g., listening to songs) evoke memories that can cause transference and countertransference. He explained that “the women connected to the ‘deep’ as their personal darkness”—for example, they rolled into the criminal lifestyle but were unable to roll out of it.
Listening to songs can be a powerful medium that touches clients on a deep emotional level, especially when the song has a “personal connection to specific events in the client’s life.” Walter reported that his clients shared specific parts of their lives with one another after listening to the song and that these connections transcended the actual role play. He encouraged his clients to reenact movie scenes, the lyrics from a song, or group processes (e.g., “being prostituted or assaulted by a spouse or partner”). Consequently, clients shared lived experiences and commonalities with each other, thus connecting on a deeper level.
The transition between the themes of connections and relationships was seamless. These links were forged as clients saw their experiences play out in film and were able to connect to the characters in the film and other members of the group. Yannick added her perspective regarding relationships in prison, stating that inmates often try to form homogenous relationships based on race. The prison system promotes racial segregation, which keeps clients from establishing relationships with people who are different. Yannick indicated that the basis of her work with film, such as the movie Beaches (Bruckheimer-Martell, Midler, & Jeuth, 1988), provided a catalyst “to help clients understand that they can be friends with women from different cultures and racial backgrounds.” Developing relationships with diverse racial and ethnic groups encouraged a greater understanding of culture and ethnic differences and helped clients highlight shared similarities and life experiences. Discussions following the film often transitioned to role play, reinforcing what clients learned from the film. For example, the movie Beaches highlighted the lesson of friendship. Participants used lessons learned to asked questions such as “In your own life, what would you have done differently?”
The topic of relationships and healing led David and Walter to share the importance of discussing the difference between bad relationships and healthy ones. David challenged his clients to describe one type of healthy relationship and what made the relationship healthy. Films such as Hidden Figures (Gigliotti, Chernin, Topping, Williams, & Melfi, 2016), allows women to visualize what a healthy relationship with other women might look like. David and Walter believed they played a significant role in the recovery community; both men realized that many female inmates had never experienced healthy interactions with men.
The fourth and final theme, not surprisingly, is empowerment. The role of empowerment was cultivated through building the foundations of awareness and connections, which led to healthy and meaningful relationships that transcended culture, ethnicity, and race. Each theme became the basis for an emotional bridge that led to new behaviors, forgiveness, and hope for a brighter future.
Sue often shares her recovery journey with her clients and advises them that sobriety is a journey, not a destination. She has been clean and sober for fifteen years, but continues to attend Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings. Sue proudly displayed her certificates of achievement to demonstrate that in spite of battling demons related to substance dependence, there is still hope. Displaying these certificates was Sue’s way of motivating her clients and eliciting conversations about their goals. Information garnered from discussions are sometimes used to develop the treatment plan. Sue’s role as a counselor was to empower and guide her clients, help them build self-confidence, and encourage them to develop self-esteem.
Each participant reported observing their clients’ transformations and an increased sense of empowerment following the use of film, role play, or storytelling. For example, Yannick had observed clients heal, take ownership of past behaviors, and forgive others. Yannick’s goals for her clients were to become better communicators, develop positive relationships, and voice their pain, thus building healthy families and a positive future. Empowerment for Joan’s clients took the form of “I statements.” The film Gimme Shelter (Krauss & Rice, 2013) allowed Joan’s clients to better relate to the difficult tasks of making choices, moving forward, and forgiving. Each step in the healing process encouraged change, resulting in personal fulfillment. Walter’s clients also experienced personal growth; they allowed themselves to explore options and reflect on past experiences. Clients appreciated Amy’s story because it gave them hope that they too could lead fulfilling lives. Amy was confident that her clients could change once they knew it was possible.
Drug and alcohol counselors who used film as a therapeutic strategy with incarcerated women confirmed that people are primarily social learners and gain new knowledge through observation, imitation, and modeling (Bandura, 1971). Counselors reported that the use of film had been an effective tool in supporting behavioral change. Thus, this study sought to reveal how storytelling, role play, and film are used as learning strategies to change behavior in incarcerated women in the CDCR.
The insights into this form of behavioral intervention may support incarcerated women who are able to incorporate newly acquired behaviors by participating in reenactments of their stories. The theme of awareness emerged early in the analysis with counselors based on their clients’ awareness of feeling that they were not alone—hence the theory of universality. Moreover, clients developed empathy as a result of the awareness that others share in their suffering and struggle.
Conclusions and Recommendations
Female offenders are a growing population in the American justice system and are more vulnerable to trauma and abuse (O’Brien, 2002). Moreover, this population is susceptible to mental illness and substance dependency, thereby increasing the need for therapeutic and behavioral strategies that address their unique needs. Developing gender-responsive treatments and understanding women’s pathways into criminality has been a priority for researchers and clinicians alike (Kauffman, Dore, & Nelson-Zlupko, 1995). The effects of using gender-responsive interventions cannot be understated; however, this study found that utilizing storytelling, role play, and film as adjuncts to treatment can provide positive outcomes for incarcerated women.
The current findings may provide drug and alcohol counselors, social workers, and prison officials with a deeper understanding of the importance of developing alternative therapeutic strategies to help prepare incarcerated women for successful reintegration into society. Therefore, providing a flexible alternative that helps incarcerated women make connections between past trauma and the pathway to criminal behavior is essential to effective treatment. Incarcerated women find commonality with the characters in stories and are able to tell their personal stories through these characters. Additionally, film provides a way for them to make sense of lived experiences (Eisner, 1999; Eisner, 2004) and does so by providing a safe platform to tell their stories.
Inmates are able to reflect on past trauma in the context of storytelling, role play, and film. Blasco et al. (2015) proposed that cinema engages the heart and mind; thus, the arts allow clients to address traumatic events in a cognitive way. Behavioral health professionals and addiction counselors can take advantage of the use of storytelling, role play, and film to promote transformative learning when combined with structured reflection (Delamarter, 2015). For example, this study highlights the need for learning environments in which healthy relationships are cultivated.
Some clients garnered new skills necessary for healthy interpersonal relationships in a diverse environment. Incorporating the arts as an adjunct to other therapeutic interventions can enable greater client engagement in the therapeutic process. Additionally, the strategies employed by drug and alcohol counselors in this study provided an opportunity for clients to gain insight, self-worth, and a sense of empowerment that promoted more empathy. This knowledge could only have been revealed through the narrative stories of the dedicated drug and alcohol counselors who participated in the study. Results of the study may also add to the body of knowledge on therapeutic strategies, behavioral studies, innovative prison counseling programs, and prison reform.
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